Successful Aging

SUCCESSFUL
AGING
Social tips, home safety advice,

balance exercises for seniors, and
more to help you live independently
A free guide published by University Health News

UNIVERSITY HEALTH NEWS
Table of Contents
Introduction ................................................................................... 3
I. Maintaining Your Health ............................................................. 4
Exercise ................................................................................................. 4
Creating an Exercise Plan ...................................................................... 7
Diet ........................................................................................................ 9
Mental Well-Being ................................................................................12
Annual Preventative Care ..................................................................... 15
Managing the Day to Day Issues ............................................................ 17
II. Maintaining Your Mobility ........................................................ 21
Understanding Your Joints...................................................................21
Understanding Balance ....................................................................... 28
III. Know the Basics of the Major Diseases .................................... 33
Men and Women ................................................................................. 33
Men ..................................................................................................... 38
Women ................................................................................................ 38
IV. Be Aware of Age-Related Disorders ......................................... 40
V. Navigating the Medical System .................................................. 46
Choosing a Primary Care Provider....................................................... 46
Medicare 101 ........................................................................................ 47
Medicaid 101 ........................................................................................ 48
VI. Planning for the Future ........................................................... 49
Advance Directives .............................................................................. 50
Advance Directives: Common Considerations ..................................... 52
2 | Successful Aging
Introduction
Understanding how the aging process affects our minds and bodies is an
important part of preparing for our older years. The U.S. Census Bureau
reports that in 2015 there are 6.3 million Americans over the age of 85. Experts
anticipate that by 2050, that number will grow to 18.7 million.
With age comes a variety of health problems, some of which can be avoided or
minimized by certain lifestyle changes, and others which, though unavoidable,
can be better managed by certain treatments or approaches. In either case,
educating yourself about factors that affect your health is your best bet towards
healthy and successful aging and maintaining as much independence as
possible.
I. Maintaining Your Health

As we age, our bodies undergo many undesirable changes. We tend to lose
muscle mass, our organs tend to function less efficiently, and our risk of disease
increases. The good news is that there are things we can do—lifestyle choices
and changes we can make—to mitigate some of these problems.
Exercise
Exercise or physical activity is perhaps one of the most important steps you can
take towards improving your health. Multiple studies have shown that people
who are physically active are more likely to live longer and remain independent
compared with those who are inactive. And yet, a 2015 report from the United
Health Foundation states that 33.3% of seniors are not engaging in physical
activity compared with 28.7% in 2014. This is a trend that needs to change,
because exercise has the potential to make a positive impact on the aging
process.
Benefits
Longevity
Researchers have shown that exercise increases your likelihood of living longer.
While it is important to consult with your doctor if you have never been
physically active and want to begin an exercise regimen, evidence suggests that
it is never too late to reap the benefits. One study found a significant survival
benefit in people between the ages of 70 and 85 who started a physical activity
regimen compared with those who remained inactive.
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Longevity, a reduced risk of falls and diseases, and weight control are just three of the many
benefits of regular exercise.
Independent Living
Studies have shown that people who are physically active are more likely to be
able to live independently as they age. One study evaluated the physical activity
level of people at the age of 78 and found that those who were most active were
more likely to be living independently at the age of 85.
Brain Age
Exercise has a positive impact on our brains. Increased physical activity is
associated with improved cognitive function, including better executive
functioning skills like planning, organizing, and strategizing. While exercising
can help you avoid or delay developing mild cognitive impairment, it has also
been shown to improve cognitive functioning in those already experiencing
some degree of impairment.
Weight Control
Exercise can help you maintain a healthy weight and avoid obesity which, in
turn, will help reduce your risk of many diseases. Excess weight is also a burden
on the body’s musculoskeletal system and can impair your mobility.
Decreased Risk of Disease

Regular exercise has been shown to both reduce the risk of and improve
symptoms of many diseases including high blood pressure (hypertension),
heart disease, type 2 diabetes, and some cancers. It can also help prevent bone
density loss in people with osteoporosis and can improve lung function in
people with chronic obstructive pulmonary disease (COPD). Exercise, when
part of a doctor-approved program, can help speed recovery from certain
illnesses as well.
Reduced Anxiety and Depression

Exercise has been shown to improve both anxiety and depression. Exercise
releases chemicals like endorphins that can ease depression. One study of an
elderly population showed that people who exercised regularly had a 20%
reduction in anxiety compared with those who did not exercise.
Reduced Risk of Falls and Hospitalization

Exercise, particularly exercise that increases muscle mass and strength, is
associated with a decreased risk of falls and a decreased risk of being
hospitalized.
Financial Savings
By being physically fit and minimizing your risk of disease and other age-
related disorders, your need for prescription medication can decrease,
translating into what can be a substantial cost savings over the years.
Creating an Exercise Plan

It is particularly important as you age to consult your healthcare provider so
you can avoid injury before beginning a new exercise regimen. The most
effective way to embark on a successful exercise program is to find an exercise
that you enjoy and that is convenient. There are several steps you can take to
improve the odds that you will create a plan you can stick with:
• Make it Fun: Exercise does not need to be boring. Find an activity you
enjoy, whether it is walking, swimming, taking a dance or yoga class, or
hiking. There are many different ways to get exercise.
• Make it Convenient: Find a place that is easy to get to for your

exercise so that getting there does not become burdensome.
• Keep a Schedule: Find a time of day and pick certain days of the week
when exercising will best fit into your routine.
• Make it Social: Finding a partner to exercise with, or joining a class at

a gym or community center can not only keep you motivated, but can
make the process more enjoyable.
• Be Smart: Consult with your doctor on a plan that is healthy for you.
Leave yourself time to warm up your muscles before taxing them with
more rigorous exercise. If it causes pain, you need to reevaluate your
regimen. Be willing to readjust your routine if you have an illness or
injury that prevents you from doing the exercise you are used to doing.
What Types of Exercise Should I Do?

There are four main categories of exercise. Which type(s) you decide to
incorporate into your regimen should depend on your health and medical
problems. Your doctor can help guide you in creating a safe regimen.
© Robert Kneschke | Dreamstime.com

There are four basic types of exercise: aerobic, balance, flexibility, and (pictured) strength
training. Your doctor, physical therapist, or fitness trainer can help you create a customized
program that fits you.
• Aerobic: Engaging in an exercise that safely raises your heart rate or

makes you breathe a little harder can help build up your stamina and
energy level. Most experts recommend trying to get 30 minutes a day of
this kind of exercise, at least several days a week. If 30 consecutive
minutes is too much for you, you can break it into 10-minute segments
throughout the day. A study of people between the ages of 60 and 83
showed that this type of exercise was the most beneficial in terms of
reducing abdominal fat and C-reactive protein levels (a marker of

inflammation), both of which are linked to heart disease and diabetes.
• Balance: Balance exercises such as heel to toe walking can help you
reduce the risk of suffering a fall.
• Flexibility: Stretching exercises keep your muscles limber and can help
keep you flexible. Increased flexibility not only helps keep you mobile,
but also helps prevent strains and sprains or other types of muscular
injury.
• Strength Training: This type of exercise which includes activities like

squats or push-ups helps you maintain muscle mass. Muscles are
important for many reasons. Since muscles are what support your joints,
stronger muscles can help reduce arthritis symptoms and avoid joint
injuries.
Diet
The food we eat is the fuel for our bodies. It also has a significant impact on our
risk of disease development and disease management. Most experts agree that
a diet rich in whole grains, fruits, vegetables, lean proteins, and nuts
and low in processed foods and refined carbohydrates is what we
should aim to consume. The amount of food we eat is also important. Watching
our total caloric intake and keeping an eye on portion control can help avoid
weight gain.
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It’s basic but proven advice: To be your healthiest self as you age, make sure your diet is rich
in fruits and vegetables—and avoid high-sugar foods, high-salt foods, high-fat foods, and
processed foods.
What to Include
Fruits and Vegetables

Fruits and vegetables, in addition to having fiber, are often rich in vitamins and
minerals that have important health benefits. For example, dark leafy greens
such as kale and spinach contain calcium needed for bone mass and the beta-
carotenes and vitamin C found in peppers and cantaloupe can help fight certain
eye diseases like macular degeneration. Certain fruits and vegetables also
contain antioxidants, substances that help fight damaging free radicals in our
bodies, which can help prevent a variety of problems from certain cancers to
aging skin. Examples of antioxidants are the anthocyanins found in
blackberries and blueberries and the lycopene found in tomatoes.
Whole Grains
Whole grains such as brown rice, quinoa, and whole oats, are rich in fiber. A
diet containing whole grains can help prevent and manage diabetes. It can also
help promote regularity.
Lean Proteins
Protein is essential for maintaining muscle mass. Examples of lean proteins are
fish and legumes. Fatty fish such as salmon or tuna have the added benefit of
containing omega-3 fatty acids, which have a protective effect against heart
disease, stroke, and Alzheimer’s disease. Legumes such as beans and lentils are
a fiber-rich, low-fat and an inexpensive source of lean protein.
Low-fat Dairy/Calcium-Fortified Dairy Substitutes

Low-fat dairy products such as skim milk or low-fat yogurt contain calcium and
vitamin D, which is important in preventing bone loss or osteoporosis. If you
cannot eat dairy, look for alternatives such as calcium-fortified almond or soy
milk.
Nuts
While nuts have a relatively high fat content, the fats they contain—
monounsaturated and polyunsaturated fats—are the healthy kinds of fats. Nuts
are also high in protein, omega-3 fatty acids, and fiber among other nutrients
and have been linked with a decreased risk of heart disease and stroke. It is
important to bear in mind that nuts are high in calories and some nuts come
prepared with added sugar and salt, all of which can counteract the positive
health benefits.
What to Avoid
• High Sugar/Processed Foods: Foods high in sugar can raise your
blood glucose levels, leading to an increased risk of diabetes and weight
gain.
• High Fat Foods: Foods high in saturated and trans fats increase your
risk of heart disease and stroke by contributing to the build-up of
plaques in the arteries of the heart and brain in addition to other places
like our legs (resulting in peripheral artery disease).
• High Salt Foods: High salt consumption has been linked with an
increased risk of developing high blood pressure and kidney disease. In
addition to watching the salt that you cook with or season your food
with, it is important to check food labels for sodium content.
Mental Well-Being
The changes that our bodies undergo as we age can sometimes affect our
emotional health. It can be frustrating and discouraging to experience new
physical limitations or new medical conditions. There are a number of steps we
can take, however, to help maintain a positive outlook on life.
Get Moving
Exercise leads to a release of chemicals in our brains called endorphins that are
associated with a “feel good” effect. Multiple studies have linked exercise with a
reduction in anxiety and depression.
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Social outings can be important at any age, and especially as we get older. Socializing helps
keep our brains working, research shows.
Be Social
Research has consistently demonstrated that regular interaction with other
people is associated with a reduction in cognitive decline; in other words, it is
good for our brains to socialize. There are many ways to increase our
interaction with others:
• Exercise Together: Take a walk with a friend or neighbor, join a class

at a gym or community center
• Brain Games: Brain-building games like Sudoku, crossword puzzles, or

bridge, when played with others, can have a very positive impact on our
cognitive function and our mental well-being.
• Meals: Plan a regular weekly meal with a friend or group of friends.
• Volunteer: There are many organizations, from hospitals to museums,

in need of volunteers. It can be an excellent way to interact with others
and to feel like you are making an impact on your community.
• Special Interest Groups: Join a book group at your public library, a

class at your place of worship, or a support group. Check with your
public library or community center for a list of groups that meet on a
regular basis.
Be Self-Compassionate
Research has shown that when we are compassionate towards ourselves—treat
ourselves kindly and nonjudgmentally—we tend to have better adaptive
functioning skills, improved quality of life, and a greater sense of well-being in
our older years.
Practice Mindfulness
Mindfulness is the ability to focus on the present moment, awaken to
experience, and acknowledge and accept out thoughts and feelings. Research
has found that practicing mindfulness can slow the aging process at the
neurological and chromosomal level. In fact, our brains normally shrink 5%
every 10 years after the age of 40; however, studies have shown that people who
regularly practice mindfulness have less age-related loss of brain volume.
Meditation is a common mindfulness practice, but there are many other small
ways to start practicing mindfulness, including:
• One-Minute Breathing: This is something you can do anywhere and

at anytime. Take a minute and breathe in slowly and deeply, focusing on
your breath. Hold your breath for several seconds and then slowly
exhale. If your mind wanders, acknowledge your thoughts but don’t
judge them.
• Observation: Sit still for a moment and pick a natural object around
you such as a tree branch or a butterfly. Try to feel as though you are
noticing it for the first time and observe the way the wind blows the
leaves or the butterfly’s wings flutter. Appreciate the nuances of the
movements.
• Mindful Action: Take a moment to perform an activity you do on a

regular basis, but slow down and allow yourself to notice everything
about it. For example, as you fill the coffee pot with water, watch your
hands, observe the flow of the water, consider how your brain is
directing your hands to hold the pot and turn on the faucet.
Get Help When You Need It

Depression is not a normal part of aging, but the elderly are at increased risk of
experiencing depression. Depression is also more common in people with
chronic medical problems and data shows that over 80% of older people have
at least one chronic medical condition. If you are experiencing symptoms of
depression such as loss of interest in activities you once enjoyed, irritability,
feelings of hopelessness, insomnia or excessive sleeping, you should seek
medical help. There are many options for treating depression and anxiety,
including medications and cognitive behavioral therapy, and your healthcare
provider can help guide you towards the right treatment option.
Annual Preventative Care

Seeing your primary care provider on at least an annual basis allows him or her
to help keep tabs on your overall physical health. If you have chronic medical
problems, however, the visits with your provider can sometimes be dominated
by focusing on the management of those problems. It is important to remember
that as we age, there are a number of yearly preventative measures we should

take:
Immunizations
As we age, our immune systems stop
functioning as well as they used to,
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putting us at increased risk of acquiring
infections. As a result, it is critical that the
elderly stay up-to-date on immunizations.
In particular, it is important to get:
Shingles Vaccine
The Centers for Disease Control (CDC)
recommends that all people over the age
of 60 receive the shingles vaccine, a one-
Don’t forget your annual flu shot!
time shot designed to prevent the painful
skin rash and nerve pain caused by the shingles virus.
Tdap
The CDC recommends that people get the tetanus, diphtheria, and pertussis
(whooping cough) booster every ten years.
Pneumococcal vaccine
All adults over the age of 65 should receive a pneumococcal vaccine to prevent
infection (pneumonia, meningitis, sepsis) caused by the pneumococcal
bacteria. There are two types of the vaccine, and you should discuss with your
healthcare provider which one(s) you need.
Annual Flu Shot

People over the age of 65 are at increased risk of serious complications from
influenza infection, therefore it is critical that they get the flu shot every year
before flu season starts (early fall).
Annual Eye Exams

There are many different eye conditions such as macular degeneration and
cataracts that can affect vision in the elderly. Often when people’s vision starts
to deteriorate, they will go to their local drug store and buy an inexpensive pair
of reading glasses in the hopes of solving their problem. It is important,
however, to see your eye doctor so that he or she can evaluate you for more
serious eye conditions. Early treatment can help delay and prevent progression
in many of these conditions.
Oral Health
More than 70% of Americans over the age of 65 have some degree of gum
disease. Gum disease is the leading cause of tooth loss and studies have shown
that tooth loss is associated with both physical and mental decline.
Additionally, gum disease has been strongly linked with heart disease. Good
daily oral healthcare and yearly visits to your dentist are an important part of
maintaining your overall physical health.
Managing the Day to Day Issues

Many of the day to day tasks we took for granted when we were younger
become more onerous in our older years. It is important to ask for help when
these tasks become difficult and to take advantage of resources in the
community to help meet some of our needs.
Meals
Grocery shopping and meal preparation can become difficult tasks in later
years, particularly if you are no longer able to drive or suffer from conditions
that prevent prolonged standing or lifting. Many community centers have meal
programs for senior citizens and/or information on Meals on Wheels programs.
Try calling your local community center, local library or chamber of commerce
for a list of such programs. Asking friends or family for assistance with grocery
shopping or hiring someone to do it for you are other options.
Transportation
Driving in later years can be challenging as our reflexes slow and our vision
deteriorates. Many communities have transportation programs for the elderly.
You can visit www.eldercare.gov or call 1-800-677-1116 to find out what options
exist in your community.
Hygiene
Maintaining good personal hygiene is important. This can be complicated if
you suffer from incontinence. If this is a problem for you, you should discuss it
with your healthcare provider so that they can help determine the cause of your
incontinence and possible treatment and daily management options.
Additionally, good oral hygiene is also important to prevent gum disease and
even heart disease. Our skin is often thinner and more prone to infection as we
age, so keeping it clean is critical. However, simply taking a shower or bath can
become very difficult tasks for the elderly. Often, having a walk-in-tub or a
shower seat and shower handle bar are absolute necessities for maintaining the
ability to bathe independently. Even with this equipment, it can be sometimes
be necessary to have someone assist you in the bathing process. If family is not
an option, you might need to have a home health provider come on a regular
basis. Your healthcare provider can help direct you towards local care resources
or you can visit www.eldercare.gov or call 1-800-677-1116 for local options.
Getting Around
Walking around your home can become a dangerous activity as we age,
particularly if you suffer from balance problems or arthritis. Taking certain
precautions can make it safer:
Footwear
Make a point to find comfortable shoes that give you the type of support (for
example arch support) you need. Your healthcare provider, podiatrist, or
physical therapist can help you determine the right type of shoe for you.
Research suggests that it is not safe to walk in stocking feet without shoes as
your risk for falls might be increased.
Assistance Devices
If you suffer from balance problems or have limited mobility you might be in
need of an assistance device such as:
Canes
Canes can relieve pressure on joints, provide stability and help prevent falls.
Canes can be found at medical supply stores and regular pharmacies. It is
important to find a cane that is the appropriate height, handle, and design for
your needs. If you are not certain what those requirements are for you, consult
with your doctor, physical therapist, or medical supply store staff.
Walkers
Some people need the wider base of support that walkers provide. Walkers can
be purchased at medical supply stores or ordered online.
Scooters/Wheelchairs
When walking is no longer an option, it may be necessary to obtain a scooter or
wheelchair. If your doctor agrees that this is necessary, Medicare and many
insurance companies will help cover some or all of this expense. You should
consult with your healthcare provider, insurance company, and Medicare
(www.medicare.gov/supplier or 1-800-MEDICARE) to determine where you
should obtain your device.
II. Maintaining Your Mobility

Maintaining our mobility is one of the most important factors in maintaining
independence as we age. Many factors can influence our mobility, particularly
our joints and muscles and our balance.
Understanding Your Joints

Our skeletal system is the scaffolding of our body, providing structure and
support. Joints are the parts of the bodies where different bones come together,
allowing our skeletons to move. Healthy joints contain cartilage, synovial
membranes, and synovial fluid that provide cushioning. As we age, joints can
be affected in a number of ways. Our bones lose mass and become more brittle
and prone to fracture. The fluid content diminishes and the cartilage can wear
away. Mineral deposits or calcifications can develop around the joints,
restricting movement and causing pain. The symptoms experienced by these
changes and the problems that occur with age are different for each joint.
Knees
The knee is the strongest and largest joint in our body and bears the burden of
the majority of our body weight. The end of the femur (or thighbone), tibia (or
shinbone), and the patella (or kneecap) meet in the knee joint. Articular
cartilage cushions the bones as the knee bends and straightens. Two other
pieces of cartilage, called the meniscus, provide cushioning between the ends of
the femur and tibia. The entire joint is surrounded by a synovial membrane
that secretes a fluid that lubricates the joint. The most common knee problem
in the elderly is osteoarthritis of the knee. In osteoarthritis, the cushioning
cartilage wears away to varying degrees, allowing the bone to rub against bone.
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Symptoms
• Pain: This can range from a mild ache to debilitating pain. Some people
report feeling more pain with changes in the weather.
• Swelling and Stiffness: Some people experience this most after

sitting or resting.
• Crepitus: A click or creak of the joint can sometimes be heard from

loose pieces of cartilage in the joint.
Treatment
• Muscle strengthening Exercises: Your doctor or physical therapist
can help you determine what exercises (such as quad sets that
strengthen the quadriceps or thigh muscles) you can do to help
strengthen the muscles that support your knee joint.
• Modify your workout: Switching from high impact exercise like

jogging to low impact exercise like swimming or cycling reduces the
stress on your knee.
• Weight loss: Lowering the burden of weight that your knees must bear
can have a significant impact on pain reduction and increased mobility
of the joint.
• Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) are

often used to treat the pain and inflammation of arthritis, but they can
have serious risks including gastrointestinal bleeding, so you should
consult your doctor before taking them.
• Knee Replacement: Knee replacement is the treatment of choice

when all other treatment options have failed.
Hips
Much like the knee, the most common hip affliction in the elderly is caused by
osteoarthritis, or “wear and tear” arthritis. Hip fractures, however, can also
occur in older people and the risk of having a hip fracture increases with age as
well as with other medical conditions like osteoporosis, cancer, and a history of
long-term steroid use. Hip fractures can have serious consequences in the
elderly and require immediate medical attention and often surgery.
The hip is another of the body’s largest joints, but unlike the knee, it is a ball-
and-socket joint. The “ball” is the head of the femur (thighbone) and the socket
is the surface of the pelvic bone called the acetabulum. As with the knee, the
bony surfaces of the joint are covered by a cushioning articular cartilage and
the entire joint is surrounded by a lining that secretes a lubricating fluid. When
this cushioning cartilage begins to degenerate, the symptoms of hip
osteoarthritis begin to appear.
Symptoms
• Pain: Pain around the hip joint, but also occasionally pain in the groin
or thigh that radiates to the buttocks or knee, can occur with arthritis of
the hip. Vigorous activity and changes in weather can aggravate the pain.
• Stiffness and Swelling: People with arthritis of the hip may have
stiffness and swelling that can interfere with range of motion and
walking and often cause a limp.
• Crepitus: As with arthritis of the knee, you may experience a locking of

the joint or a grinding noise caused by loose tissue in the joint.
Treatment
• Muscle Strengthening Exercises: Exercises designed to strengthen
the muscles that support your hip joint or the muscles of your leg can be
a good way to ease the work of the joint. Your doctor or physical
therapist can help you create a regimen of strengthening and stretching
exercises best suited for you.
o Modify Your Workout: Switching from high-impact exercises like

tennis to low impact exercises like swimming can reduce the wear and
tear on the remaining cartilage in your hip.
! Assistive Devices: Depending on the degree of your arthritis, using a

cane or walker may help increase your mobility and independence by
providing more support and stability.
• Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) are

often used for pain management with arthritis. The carry significant
risks such as gastrointestinal bleeding, so be sure you discuss them with
your healthcare provider, particularly if you require them often.
Sometimes corticosteroid injections into the joint space are used to
control pain and inflammation as well.
• Hip Replacement: For hip pain that cannot be managed with non-
surgical means, replacement surgery may be the next step.
Feet
Our feet are at risk for a number of problems as we age. The foot arch starts to
weaken, often resulting in a small loss of height. Additionally, circulation to the
feet can be compromised, particularly in people with peripheral artery
disease (in which plaques build up in the arteries of the leg) or diabetes (in
which the blood vessels to the leg become damaged by high blood sugar levels).
As with the rest of the body, our skin also thins and is more prone to injury
which, along with diminished circulation, can lead to an increased risk of
infection, particularly in people with diabetes. There are several things you can
do to avoid complications with your feet:
• Exercise: Exercise can strengthen the muscles and arches of your feet
and promote better blood circulation. If you are already experiencing
foot problems, consult with your physical therapist or podiatrist to
discuss a suitable exercise regimen.
• Hygiene: Keeping your toenails clipped is an important step towards

avoiding pressure sores and ingrown toenails which can lead to
infection.
• Footwear: Wearing footwear that provides the right support and is the
right size can ease foot pain. Keeping your feet covered can also keep
them warm and increase circulation, although it is important to not wear
socks or shoes that are so tight they restrict circulation.
• Check Your Feet: Given the increased risk of developing sores or

infection in your feet, it is important to inspect them regularly so that
early signs of infection can be detected.
Back/Spine
Our spine is composed of multiple bones called vertebrae, between which are
gel-like cushioning bodies called discs. The spinal cord travels from our brain
down the length of the back through the center of each vertebra, sending nerves
out to various parts of our body along the way.
Every older person has some degree of degeneration of their spine, although
many are fortunate enough to remain asymptomatic. The most common
conditions of the spine related to aging are spinal stenosis (the narrowing of
some portion of the canal through which the spinal cord travels),
degenerative spondylolisthesis (the joints between the vertebrae
degenerate such that the one vertebrae slips forward on top of another),
degenerative disc disease (when the cushioning bodies between the
vertebrae become thinner and lose their fluid), compression fractures
(fractures in the vertebrae, most commonly due to osteoporosis, that cause the
height of the vertebrae to shrink), adult scoliosis or hyperkyphosis (a
curvature of the spine to the side, or a front-to-back curvature, respectively).
Spinal conditions are complicated because they are generally not isolated
conditions but are interrelated. If the spinal cord or nerves are compressed, as
they can be in spinal stenosis or spondylolisthesis, numbness, tingling, and
weakness can occur in whatever body parts the affected nerves supply. Loss of
cushioning between vertebrae in degenerative disc disease can cause loss of
motion and stiffness. Back “spasms” can occur when the muscles that support
the spine contract in an attempt to stabilize the spine.
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Spinal stenosis involves the narrowing of the canal through which our spinal cord lies and
can result in compressed nerves that cause tingling, numbness, and/or pain.
Treatment for spinal problems involves treating any underlying diseases (such
as osteoporosis) that can lead to compression fractures, physical therapy to
strengthen the supporting muscles in the back, and pain management with
acetaminophen or NSAIDs. Pain is sometimes managed with corticosteroid
injections into the vertebral space. Surgical options exist for problems that
cannot be medically managed. Because symptoms can be the same for multiple
spinal conditions, it is important to consult your healthcare provider with any
back pain so that they help determine the right diagnosis and treatment.
Muscles
Muscles are an integral part of mobility: Connecting our bones, supporting our
joints, and executing movement. As we age, multiple changes occur in our
muscle tissue. Our lean muscle mass begins to decrease, in part because fat and
an age-related pigment called lipofuscin begin to be deposited in our muscle.
Muscle tissue is replaced more slowly with age and is often replaced with
tough, fibrous tissue which can be most evident in our hands. Muscle tone and
flexibility are also diminished both because of decreased muscle mass and age-
related changes in our nervous systems.
Physical activity, particularly muscle strengthening and stretching exercises, is

key to minimizing the effect these changes have on our mobility and
independence. Exercise also increases the blood flow to our muscles, further
optimizing their function. Consult your doctor or physical therapist before
beginning a new muscle strengthening regimen to ensure you do not incur
injuries. Maintaining a diet with adequate protein—the building block of
muscle-- is also important for replacing muscle mass.
Understanding Balance
Balance problems are one of the most common reasons people over the age of
65 consult their healthcare provider; in fact, some data suggests that 40% of
seniors are affected by balance problems. Balance is defined as the ability to
maintain the body’s center of mass over its base of support. This is achieved by
a complex interplay of input to the brain from our eyes, our muscles and joints,
and the vestibular organs in our inner ear. Our vision allows us to take stock of
where our body is in relation to other objects. Our muscles and joints, with
input from nerves, allow us to sense where our body parts are and need to be.
Our vestibular system helps our brain track the position of our head with
respect to gravity.
How Aging Affects Balance

Even in the absence of other medical conditions, our risk of developing balance
problems increases with age for a variety of reasons:
• Cells in the vestibular system begin to die off
• Our vision diminishes
• Hearing deteriorates
• Muscle mass and strength deteriorate
• Reflexes slow
Health Conditions that Can Affect Balance

Many different health conditions can impact our balance:
• Eye Disorders: As vision is an important part of the sensory input that

helps us maintain balance, conditions that affect our eyes can impact
balance. Eye muscle imbalance, cataracts, macular degeneration,
diabetic retinopathy are examples of such conditions.
• Arthritis: The pain and the limitations on range of motion that arthritis
can cause in our joints can impact our ability to maintain our center of
gravity over a stable base of support. Arthritis can cause changes in
posture that impact balance as well.
• Nerve Problems: The nerves in our feet and legs tell our brain where
these body parts are and provide them with the signal from our brain to
move. Many diseases can affect these nerves, and thus our balance,
including multiple sclerosis, Parkinson’s disease, stroke, and diabetes.
• Diabetes: In addition to affecting the nerves in our feet and legs,

diabetic neuropathy can affect the nerves in our autonomic nervous
system that help us stay steady as we go from lying down to standing.
Diabetes can also affect our vision and increase the risk of stroke. Low
blood sugar levels can also undermine our balance, causing
lightheadedness or weakness.
• Ear Disorders: The inner ear is a critical part of maintaining balance.

Localized ear infections, upper respiratory infections or vertigo can all
affect the vestibular system of the inner ear and, thus, our balance.
• Dehydration: Dehydration can affect our ability to tolerate changes in

posture.
• Side Effects from Medications: Many different medications can

impact our balance. Examples include blood pressure lowering drugs
(diuretics, ace inhibitors, etc), some antibiotics, chemotherapeutic
drugs, antihistamines, and sleep aids, among others. Additionally, the
interaction of different medications can affect balance.
Diagnosing and Treating Balance Problems

If you are experiencing problems with your balance, you should consult your
healthcare provider. If your balance problem is related to an underlying
medical condition, identification and treatment of that condition may improve
your balance. If you have not already been diagnosed with an underlying
condition, physical examination can often determine whether the problem is
musculoskeletal, neurologic, or vestibular. Your primary healthcare provider
may refer you to an ears, nose, and throat (ENT) doctor if they suspect the
cause is related to your vestibular system. There are several different problems
that can affect the vestibular organs in the inner ear. In the elderly, the most
common of these is benign paroxysmal positional vertigo in which calcium
particles build up in the canals of the inner ear. Treatment usually involves
physical maneuvers that make use of gravity to get the particles dislodged from
the canals.
Improving Your Balance

The ability to maintain balance is key to preventing falls that lead to fractures
and head injuries. There are steps you can take to improve your balance.
• Balancing Exercises: In addition to regular aerobic and muscle

strengthening exercises, there are specific balance exercises you can
practice. If you have underlying medical conditions, you should consult
your healthcare provider before beginning balance exercises. He or she
may refer you to a physical therapist who can create a regimen best
suited to your needs. If you are otherwise healthy, there are several
exercises you can do at home; however, you should begin slowly to
ensure your ability to safely perform them:
• Heel-to-toe Walking: Walking in a straight line, place the heel of one

foot in front of the toes of the other foot. Walk across a room in this
pattern, attempting to stay on a straight course.
• Single Leg Stand: Holding on to the back of a chair, lift one leg and
balance your weight on the other leg for 20 seconds. As your steadiness
improves, you can perform this without holding onto the chair.
• Balance Walk: Raise your arms on both sides to shoulder height and
walk in a straight line, one foot in front of the other. As you walk, lift the
back leg and hold it up for one second. Keep your arms raised at all
times.
• Assistance Devices: If you suffer from a medical condition that

affects your balance such as arthritis or Parkinson’s disease, or if you
have suffered a stroke, you may need to use a cane or walker to help you
maintain your balance. Medical supply stores carry these and can help
you find one that fits your body and your needs.
Preventing Falls
Falls are the leading cause of injury in people over the age of 65. Problems with
balance can increase your risk of a fall, but falls can also occur because of
hazards in the environment such as walking on wet surfaces. Taking measures
to improve your balance can go a long way towards preventing falls.
Additionally, since 6 out of 10 falls occur in the home, there are also steps you
can take to make your home more fall-proof:
• Install railings on stairways
• Install grab bars in bathrooms next to toilets and in bathtubs and

showers
• Get rid of loose rugs or carpets that pose slip risks
• Create space: Arrange furniture so that you have wide, clear paths to
walk through from room to room.
• Improve your lighting: Be sure you have adequate lighting so that you
can see where you are stepping.
III. Know the Basics of the Major

Diseases
There are many different diseases that can affect the human body, but certain
disease rank among the most common causes of major illness in older adults.
Your healthcare provider will screen you for obvious signs and symptoms of
these diseases at your annual check-up; however, if you ever suspect you are
suffering from one of these diseases, you should see your healthcare provider
immediately. Some of these diseases affect both men and women and others
are gender-specific.
Men and Women
Cardiovascular Disease
Cardiovascular disease is a term that is primarily used to refer to the effects of
atherosclerosis, the build-up of plaques in our arteries. As the plaques build up
they begin to block the flow of blood through the arteries. These plaques can
build up in the arteries of the heart, creating coronary artery disease (the
cause of heart attacks), in the arteries of the brain, which can cause stroke by
blocking blood flow (called ischemic stroke), and in the arteries of the feet and
legs, causing peripheral arterial disease.
Risk factors for atherosclerotic cardiovascular disease include family history,

obesity, abnormal cholesterol levels, smoking, diet high in saturated fats, and
lack of exercise. Sometimes, people use the term cardiovascular disease to refer
to other conditions affecting the heart such as heart failure (when the heart
cannot pump blood to the body efficiently), arrhythmias (abnormal heart
rhythms), and heart valve problems (when the valves of the heart don’t
work properly to keep the blood flowing in the right direction).
Lifestyle changes such as exercise, better diet, and smoking cessation are part
of the treatment regimen for most types of cardiovascular disease. Depending
on the type of cardiovascular disease you have, your healthcare provider may
prescribe medications to prevent blood clots, lower cholesterol levels, improve
your heart’s pumping ability, or control your heart rate.
Stroke
Ischemic stroke, the most common form of stroke, occurs when the flood of
blood in a vessel in the brain is blocked by an atherosclerotic plaque or blood
clot. Risk factors for ischemic stroke include family history, heart disease, high
blood pressure, smoking, diabetes, obesity, sedentary lifestyle, poor diet, and
abnormal cholesterol levels. Hemorrhagic stroke occurs when the wall of a
blood vessel in the brain weakens and bursts causing bleeding into the brain.
This is usually the result of a long history of high blood pressure. If you have
had a stroke, treatment includes treating the underlying condition that led to it
(e.g. high blood pressure or blood clot formation) as well as physical and
occupational therapy of the affected parts of your body.
Lung Cancer
Lung cancer is the leading cause of cancer deaths for men and women. The
biggest risk factors for developing lung cancer are a history of smoking or long-
term exposure to secondhand smoke; however, some lung cancers occur in
people who have never smoked. Exposure to certain carcinogens (cancer-

causing chemicals) such as asbestos is also a risk factor for some lung cancers.
Lung cancer treatment can include chemotherapy, radiation, and sometimes
surgery.
Chronic Obstructive Pulmonary Disease (COPD)

COPD is a disease in which chronic inflammation in the lungs obstructs
airflow, resulting in progressive breathlessness. There are a number of different
types of COPD including emphysema, chronic bronchitis, and non-reversible
asthma. Risk factors for COPD include smoking or history of exposure to
second-hand smoke, exposure to fumes or small particles, and family
history/genetics. Treatment for COPD can include drugs that help dilate the
airways in your lungs (bronchodilators) and decrease the inflammation in the
airways (steroids, phosphodiesterase-4 inhibitors) as well as other drugs like
theophylline. Oxygen therapy and monitored exercise regimens can also be
prescribed.
Alzheimer’s Disease
Alzheimer’s disease (AD) is the most common cause of dementia. It is a
progressive, degenerative disease in which, for mostly unexplained reasons, the
build-up of beta-amyloid plaques and the tangling of tau proteins in the brain
leads to brain cell death. It is thought that interplay of genetics, environment,
and lifestyle is behind the cause of AD. Among the identified risk factors are
family history, history of head trauma, older age, diabetes, and lifestyle factors
such as lack of exercise, poor diet, and smoking. Treatment includes
medications such as cholinesterase inhibitors and memantine as well as taking
measures to provide the necessary daily care required for those experiencing
cognitive impairment.
Diabetes
Diabetes is a disease characterized by elevated blood sugar (glucose) levels. In
type 1 diabetes the body does not produce enough of the hormone insulin that
allows our cells to take glucose up from the blood stream. This form of diabetes
is more commonly diagnosed in younger people.
Type 2 diabetes is characterized by the cells of the body being resistant to the
effect of insulin. The body will initially try to compensate by producing more
insulin, but will ultimately not be able to do so. This type of diabetes is more
commonly diagnosed in adults.
Diabetes can have dire consequences on the body, causing damage to the small
blood vessels of virtually every organ. This can result in disorders of the eye
(such as glaucoma and retinopathy), ears (hearing loss), kidney (kidney
failure), cardiovascular system (such as heart disease), nervous system (nerve
damage or neuropathy) among others. Treatment is centered around keeping
blood glucose levels within a normal range either by using insulin (in type 1
diabetes), oral glucose-lowering medications (in type 2 diabetes), or both (in
type 2 diabetes).
Colorectal Cancer
Cancer of the colon or rectum is the second leading cause of cancer death
affecting men and women in the United States. This cancer begins in the form
of polyps that grow in the large intestine and become cancerous over time.
Screening with colonoscopy can help prevent these cancers by allowing for the
biopsy and removal of these polyps. Treatment depends on the stage of
colorectal cancer but can include chemotherapy, radiation and/or surgery.
Influenza and Pneumonia

Infection of the lungs caused by influenza or bacteria is a major cause of death
among people over the age of 65. This is in part because as we age, we are
sometimes not able to clear the secretions from our lungs as well, allowing for
bacterial growth and decreased oxygen exchange. Our immune systems tend to
be weaker as we age and the odds of having a co-morbid condition that impairs
our ability to fight infection (such as diabetes) increase. Being sure that you
receive your pneumococcal vaccine once you turn 65 and your annual flu shot
can help prevent you from getting pneumonia. If you are diagnosed with
pneumonia, treatment may include antibiotics or antiviral medications.
Hospitalization and oxygen therapy may be necessary for more severe cases.
Chronic Kidney Disease

Chronic kidney disease is the gradual loss of kidney function. This can
ultimately result in the kidneys losing the ability to filter waste from the blood
into urine, leading to dangerous build-up of fluids, electrolytes, and protein in
the blood. Risk factors for the development of kidney disease include diabetes,
high blood pressure, obesity, advanced age, abnormal cholesterol levels,
smoking, and family history among others. Treatment includes managing any
underlying condition that is contributing to the kidney disease (such as
diabetes or high blood pressure), dietary changes to limit the salt and protein
content of your blood, and drugs to minimize swelling from excess fluid
retention. If the disease progresses, you may need dialysis (filtering of the
blood by a machine) or even a kidney transplant.
Men
Prostate Cancer
Cancer of the prostate gland is one of the most common cancers among men. It
is often diagnosed after a man begins experiencing symptoms such as trouble
urinating, erectile dysfunction, blood in the semen, or pelvic pain. Doctors can
screen for prostate cancer by physical examination and with blood tests such as
the prostate specific antigen (PSA) test; however, scientific opinion on the
effectiveness of these screening methods is controversial. While it is unclear
what causes prostate cancer, known risk factors include increased age, African-
American race, obesity, and family history of prostate or breast cancer.
Treatment can include chemotherapy, radiation, and various types of surgery.
Women
Breast Cancer
Breast cancer is the second leading cause of cancer death in women after lung
cancer. There are different types of breast cancer, affecting different parts of
the breast. Risk factors for breast cancer include age, family history
(particularly if there is a history of carrying the BRCA-1 or BRCA-2 genes which
are linked to familial breast and ovarian cancer), past personal history of breast
or ovarian cancer, obesity, high fat diet, and high alcohol consumption. Experts
agree that there is a strong link between prolonged estrogen exposure and
some types of breast cancer. Screening involves monthly self-exams and
mammography. Treatment can include chemotherapy, radiation, and surgery.
Ovarian Cancer
Ovarian cancer is the most common cause of female reproductive system
cancer deaths. Scientists don’t know what exactly causes ovarian cancer, but
they have identified risk factors: age over 50, history of fertility treatments,
smoking, estrogen hormone replacement therapy, family history, and
possessing the BRCA-1 or BRCA-2 genes.
IV. Be Aware of Age-Related

Disorders
Certain conditions or disorders can develop as we age that impact our quality of
life and ability to live independently.
Age-Related Disorders
Osteoarthritis
This is sometimes called the “wear and tear” arthritis. It is characterized by a
loss of the cushioning cartilage found between the bones of our joints and can
cause pain, stiffness, swelling, and decreased mobility.
Lifestyle changes such as reducing excess body weight, regularly performing

exercises that strengthen the muscles that support our joints, and changing
from high impact activities such as jogging to low impact activities such as
swimming can be helpful in managing symptoms. Additionally, pain can be
controlled with acetaminophen or NSAIDs.
Osteoporosis
The bones in our body are undergoing a constant process of change: old bone is
being broken down and new bone is being created. We reach our peak bone
mass in our mid-twenties and by middle age the rate of bone loss tends to
increase. This is particularly true of post-menopausal women.
In osteoporosis, you either make too little new bone, lose too much old bone, or
both. The end result is that the bones become weak and brittle and are prone to
fracture.
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Men and women who have lower bone density by the time the bone loss
increases are at increased risk of osteoporosis. Other risk factors include a diet
low in calcium and vitamin D, a diet high in sodium and caffeine, excess alcohol
consumption, history of smoking, sedentary lifestyle, family history of
osteoporosis, low body weight/small frame, female gender, history of taking
medications known to cause bone loss (such as steroids or aluminum-
containing antacids), and being post-menopausal.
Treatment can include medications such as bisphosphonates which slow the

breakdown of bone, increasing your calcium and vitamin D consumption,
strengthening and weight-bearing exercise, and taking measures to reduce your

fall (and, thus, fracture) risk.
Age-related Macular Degeneration (AMD)

AMD is the leading cause of vision loss in people over the age of 50. It is a
degenerative disease of the macula, a part of the eye needed for sharp central
vision. While it does not lead to complete blindness, it often results in a
blurring of the center of our vision, which can affect daily activities such as
reading and driving. Risk factors include a family history of AMD and
Caucasian race.
Treatment of AMD must be supervised by your doctor and can include a

combination of vitamin and mineral supplements (vitamins C and E, zinc,
copper, and beta-carotene have proven effective at certain doses) and, in severe
cases, injections, photodynamic therapy, or laser surgery.
Hearing Impairment
Hearing occurs because of a complex process of events that occur between our
outer, middle, inner ear and the auditory nerve that travels to our brain. As we
age, changes often occur in the middle and inner ear that diminish our hearing.
Additionally, a long history of exposure to loud noises can irreparably damage
the hair cells in our inner ear that are critical to the hearing process. Treatment
for age-related hearing loss can include hearing aids, telephone amplifiers, or
cochlear implants.
Age-related Urinary Incontinence

There are four main categories of urinary incontinence that can affect the
elderly. They are typically a combination of the effect aging has on our muscles
combined with the anatomic or physiologic effects of another condition:
Urge Incontinence
This is the most common cause of incontinence in the elderly and is
characterized by early, forceful contractions of a muscle in the bladder wall
resulting in frequent small to moderate losses of urine even when the bladder is
not full.
Risk factors for urge incontinence are a history of stroke, multiple sclerosis,
Alzheimer’s disease, Parkinson’s disease, pelvic organ prolapsed, or benign
prostatic hyperplasia (BPH). Treatment includes pelvic floor muscle exercises
and anti-spasmodic medications.
Stress Incontinence
This is more common in early menopausal women or younger elderly women
who have had multiple vaginal childbirths. It is characterized by leakage of
urine with increases in intra-abdominal pressure such as coughing, sneezing,
laughing, or exercise. Pelvic floor muscle exercises, hormone therapy, and
surgery are among the options for treatment.
Overflow Incontinence
This is characterized by a diminished urinary stream and the sensation of
incomplete voiding and can result because of outlet obstruction (as in BPH or
severe pelvic organ prolapse) or a dysfunction in bladder contractility (as in
diabetic neuropathy or spinal cord nerve compression syndromes). Treatment
depends on the underlying cause but can include surgery or medications.
Functional Incontinence
This is associated with cognitive impairment or loss of mobility that impairs an
individual from accessing a restroom. Use of disposable protective
undergarments and planned, assisted bathroom visits can be helpful

management options.
Age-related Skin Conditions

A number of changes occur in the skin with age including thinning of the skin,
loss of ability to retain water in the skin and a loss of moisturizing glands in the
skin resulting in dryness, loss of immune cells in the skin resulting in decreased
wound healing, and a loss of elasticity.
Some of these effects can be managed by regular moisturizing and inspection of

the skin for sores such that prompt treatment can be initiated to avoid
infection. Other skin disorders that can occur are:
Skin Cancers
These are commonly the result of sun exposure. It is important to see your
dermatologist regularly so that he or she can check for skin cancers.
Age Spots
These are flat tan or brown spots that usually develop in areas that have been
exposed to sun. If they are true age spots they are harmless, but any irregular
spot should be inspected by your healthcare provider.
Bed Sores/Pressure Ulcers

These are lesions that typically develop because of increased pressure on
certain areas of the body from remaining in the same position for prolonged
periods of time. They usually develop in people with decreased mobility or in
people with diabetes who have impaired circulation and immunity.
Management involves frequent position changes to alleviate the pressure on the

sores and good skin hygiene.
V. Navigating the Medical System
Choosing a Primary Care Provider

Your relationship with your healthcare provider becomes even more important
as you age and begin to face a host of new medical conditions or changes.
Having a good rapport with him or her and knowing that you can get answers
to the questions you have or appointments when you want to be seen are all
important factors in that relationship. If you find yourself in the position of
searching for a new primary care provider, one of the first decisions you want
to make is what kind of primary care provider you would like to see:
• Family Practitioner: A family practitioner is a primary care provider

for both children and adults.
• Internist: An internist is a primary care provider for adults only. All

specialists, such as cardiologists or pulmonologists, are trained as
internists before they go on to complete their specialty training.
• Geriatrician: A geriatric doctor is a primary care provider specializing

in the care of older adults. He or she has completed a family practice or
internal medicine training program and then gone on to train
specifically in caring for the elderly.
Asking friends or family for personal recommendations or other physicians (if

you see a specialist, for example) for a professional recommendation can be
good ways to get a list of possible options.
Furthermore, asking about the location of the practice (to determine its
convenience for you), asking if it is a group practice, asking who sees you when
the doctor is out of town, and asking if the doctor is board-certified (meaning
they have passed a rigorous set of qualifying tests in their specialty) can also be
helpful in deciding if the practitioner is a good fit for you.
One of the most important questions to ask is whether or not the physician is a
participating provider for your insurance plan or for your Medicare plan. The
best way to determine this is by calling your insurance company or contacting
Medicare (www.medicare.gov or 1-800-MEDICARE).
Medicare 101
Medicare is a federally funded program designed to help provide seniors with
healthcare coverage. If you are 65 or older, have collected or qualify to collect
Social Security, are a current U.S. resident and citizen, or a permanent U.S.
resident having lived in the U.S. for 5 continuous years before applying, you
are eligible to apply for Medicare coverage.
Medicare can be used alone or in combination with another insurance plan. It

is important to note that Medicare does not provide coverage for all healthcare
costs; for example, routine dental and vision care is not always covered. To
learn more about Medicare or to get help with applying and understanding
your benefits, there are many places you can turn, including:
• Medicare: www.medicare.gov or 1-800-MEDICARE
• Social Security: You can contact your local office or

call 1-800-772-1213.
• State Health Insurance Assistance Program (SHIP): Every state

has a SHIP that provides free counseling and assistance with navigating
Medicare. You can find your state’s SHIP at www.shiptacenter.org.
• Medicare Rights Center: This is a non-profit that provides help in

obtaining access to affordable healthcare for the elderly and disabled
(1-800-333-4114).
Medicaid 101
Medicaid is a federally funded program designed to provide assistance to those
who cannot afford medical care. There are a number of factors that determine
whether or not you qualify for Medicaid coverage including income, assets, and
disabilities.
For senior citizens, it may be worth applying if your income is low, you are
legally blind, have a disability, or need nursing home care. There are a number
of places to contact if you are interested in applying including:
• Medicaid: www.medicaid.gov
• Health Department: You can apply for Medicaid at your local health
department. If you do not know where your local health department is
you can ask your local hospital or visit www.naccho.org.
• Social Security Office: You can apply for Medicaid at your local social
security office or call 1-800-772-1213 for more information.
VI. Planning for the Future

An important part of preparing for the future in older age is making decisions
and preparations for end of life issues. These measures can help ensure that
you receive the care you wish to receive and can make it easier for your loved
ones by knowing what your wishes are. Many experts advise that the best time
to begin making these decisions is when you are healthy.
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Get out in front of the future by taking care of long-range planning. Your physician or local
hospital can direct you to specialists who handle advance directives (a living will or a medical
power of attorney/healthcare proxy).
Advance Directives
Advance directives are written statements of an individual’s wishes regarding
medical care made to ensure that those wishes are carried out should the
individual not be able to communicate them to their doctor. There are two
types of advance directives that most physicians recommend you have:
Living Will
A living will is a form that states your wishes regarding receiving different
forms of end of life care. You can state whether or not you would like to receive
resuscitation (with CPR or an automated defibrillator) to restart your heart if it
were to stop beating, tube feedings (through a tube passed into your stomach
from your nose or through the abdominal wall) if you are no longer able to eat,
dialysis if your kidneys stop working, mechanical ventilation if you are no
longer able to breathe on your own, or antibiotics/antiviral medications for
infections. You can also specify your wishes about what kind of palliative or
comfort care (pain medications, etc.) you would like to receive if you do not
wish to have more invasive measures taken. Living wills are also opportunities
to state whether or not you would like to donate your organs or tissues for
organ transplantation or your body for medical research. Living wills cannot be
used for medical decision making until 2 physicians have certified that you are
unable to make medical decisions and that you are in a medical condition
specified by your state’s living will law.
Medical Power of Attorney/Healthcare Proxy

When you make someone your healthcare proxy, you’re appointing them as
your surrogate decision-maker and authorizing them to make medical
decisions on your behalf in the event that you’re unable to make them. When
you choose your healthcare proxy, it’s wise to select a person you know well,
who understands your wishes, who will not be afraid to advocate for you with
your doctor, who communicates well with your family, and who is calm in a
crisis.
There are several important things to know about advance directives.
• Paramedics cannot honor either your living will or medical

power of attorney. If they are called to attend to an emergency, they
must provide emergent care until they have taken you to a hospital
where a physician can then be made aware of your advance directives.
• Laws regarding advance directives differ from state to state,

and some states will not honor an advance directive from another state.
If you spend a good deal of time in more than one state, it is wise to have
an advance directive for each state. You do not need an attorney to
create an advance directive although many people do have an attorney
help them create one.
• Your physician or local hospital can direct you to

organizations that provide state-specific advance directive
forms or you can visit www.caringinfo.org to obtain free advance
directive forms. You will have to have witnesses for all advance directive
forms and it is important to be sure that your witnesses comply with
your state’s requirements.
• Where you keep your advance directives is also critically

important. It is wise to make copies and give them to your family
members, your healthcare proxy, your physician, and your family
attorney. Since advance directives contain information regarding
matters of life or death, it is important to review your advance directives
periodically to be certain they still reflect your wishes.
Advance Directives: Common Considerations
What if I don’t have an advance directive?

If you don’t have an advance directive and become ill, there are still
opportunities to make your wishes regarding the type of care your receive
known.
Do Not Resuscitate (DNR) Orders

If you do not wish to be resuscitated with CPR or a defibrillator should your
heart stop beating, you can discuss this with your physician and he or she can
put a DNR order in your medical record.
Physician Orders for Life-Sustaining Treatment (POLST)

A POLST is the product of a discussion between an ill patient and their
healthcare provider about the patient’s wishes, goals for care, and beliefs and
the physician’s knowledge about the patient’s diagnosis, prognosis, and
treatment options. Together, the patient and physician reach an informed
decision about desired treatment and create a set of medical orders that reflect
those decisions.

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SUCCESSFUL

Social tips, home safety advice,

A free guide published by University Health News

I. Maintaining Your Health

© Robert Kneschke | Dreamstime.com

Decreased Risk of Disease

Reduced Anxiety and Depression

Reduced Risk of Falls and Hospitalization

Creating an Exercise Plan

• Make it Convenient: Find a place that is easy to get to for your

• Make it Social: Finding a partner to exercise with, or joining a class at

What Types of Exercise Should I Do?

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• Aerobic: Engaging in an exercise that safely raises your heart rate or

reducing abdominal fat and C-reactive protein levels (a marker of

• Strength Training: This type of exercise which includes activities like

Fruits and Vegetables

Low-fat Dairy/Calcium-Fortified Dairy Substitutes

© Scott Griessel | Dreamstime.com

• Exercise Together: Take a walk with a friend or neighbor, join a class

• Brain Games: Brain-building games like Sudoku, crossword puzzles, or

• Meals: Plan a regular weekly meal with a friend or group of friends.

• Volunteer: There are many organizations, from hospitals to museums,

• Special Interest Groups: Join a book group at your public library, a

• One-Minute Breathing: This is something you can do anywhere and

• Mindful Action: Take a moment to perform an activity you do on a

Get Help When You Need It

Annual Preventative Care

that as we age, there are a number of yearly preventative measures we should

© William Casey | Dreamstime.com

Annual Flu Shot

Annual Eye Exams

Managing the Day to Day Issues

II. Maintaining Your Mobility

Understanding Your Joints

© Daniel Cole | Dreamstime

• Swelling and Stiffness: Some people experience this most after

• Crepitus: A click or creak of the joint can sometimes be heard from

• Modify your workout: Switching from high impact exercise like

• Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) are

• Knee Replacement: Knee replacement is the treatment of choice

• Crepitus: As with arthritis of the knee, you may experience a locking of

o Modify Your Workout: Switching from high-impact exercises like

! Assistive Devices: Depending on the degree of your arthritis, using a

• Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) are

• Hygiene: Keeping your toenails clipped is an important step towards

• Check Your Feet: Given the increased risk of developing sores or

© Serdar Corbaci | Dreamstime.com

Physical activity, particularly muscle strengthening and stretching exercises, is

How Aging Affects Balance

• Cells in the vestibular system begin to die off

• Our vision diminishes

• Muscle mass and strength deteriorate

Health Conditions that Can Affect Balance

• Eye Disorders: As vision is an important part of the sensory input that

• Diabetes: In addition to affecting the nerves in our feet and legs,

• Ear Disorders: The inner ear is a critical part of maintaining balance.

• Dehydration: Dehydration can affect our ability to tolerate changes in